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Health Insurance

In Canada, each province provides provincially funded health plans for medical services for residents of that province. This has become an effective and recognized health care system. Unfortunately, this funding is limited in its application to only mandatory health services.

 

Essentially only services that are deemed necessary medical services are covered but the coverage given can be the full amount or only a percentage (depending on the province) and the individual must pay the remaining costs.

 

Most provincial governments will pay the full costs of regular physician visits, one-time eye examination every 24 months and basic hospital accommodations (including any mandatory prescriptions while admitted).

 

These costs can be very expensive for individuals that do not have the funds readily available or if they are not covered from provincial health plans (i.e. new residents of Canada). Individuals who have recently come to Canada are not immediately added to provincial health coverage for a minimum 3 month waiting period. Individual Health insurance coverage can be used as a short term coverage plan that covers health services, dental and medical emergencies. It is highly recommended that new individuals entering Canada purchase health insurance in order to cover for any unforeseen medical services.

 

Individual Health Insurance Policies are designed to fill in the gaps in your insurance coverage beginning where your provincially funded health plan ends. Services not provided by your provincial health plan include dental care, prescription drugs and eye care (glasses and contacts). Every Canadian resident or citizen will require at least one if not all of these services at some point in his/her life.

 

Depending on your health insurance policy, a large percentage or full coverage can be applied to your health service costs. It also works in combination with any group health plans through employers and helps provide additional coverage that a group plan may not include. Each individual needs are different and your health insurance policy can reflect your needs and ensure that you and your family have the coverage that is needed for you.

Who Needs Individual Health Insurance?

Everyone should consider purchasing a type of health insurance policy. Each policy can be created to meet your individual needs and situation to guarantee you have the best coverage.
Individuals should get health insurance if he/she is:

  • Working part-time, is self-employed or does not work;
  • Is a new resident of Canada and is on the waiting list for provincial health funding;
  • Working full-time but needs to fill in the gaps provided from a group insurance plan;
  • Single or married;
  • Has a dependent(s)

Do I Need Health Insurance If I Already Have Group Insurance?

Most individuals do consider purchasing health insurance even if they are a part of a group plan at work. Each group policy offers a range of benefits for employees however they are not individual specific. The same benefits and rates are applied to all individual members. Some may exclude or include services that do not match your needs and therefore services you may require are not covered. For example, certain policies may cover health services but not dental plans or cover dental plans but not prescription drugs. Further because each group plan is managed by the policy holder (employer), group members are unable to opt in for additional coverage or amend the benefits being offered.

 

Individual Health Insurance Policies are a way to fill in the gaps between your provincially funded health plans and your group policy. This can be by providing additional benefits in your coverage or the policy can be used to pay the remaining costs not covered by your group plan.

Options for Individual Health Insurance Policies

  • Renewal

Most individuals wish to purchase a health insurance policy that is renewable and therefore this is generally a starting point when comparing different health insurance contracts.

 

  • Grace Period

Although there is no legal obligation, some policies will provide the insured with a 30-31 day grace period where the insurance policy is still in effect even after the premium payment is due.

 

  • Claims

Policies can be created so that the insurance company will directly pay for services that are pre-chosen with the company and therefore the charges are billed to the insurance company directly from the health service place. This helps manage the costs and quality of care for the insured as reduced costs are generally given to individuals apart of these particular plans.

 

The second option allows for the insured to go to any health care provider and pay for the service. After payment and billing has been completed the paperwork will be sent to the insurance company for reimbursement. The percentage amount covered by the insurer is determined on the policy contract and coverage options agreed upon with the insured.